This brings a perfect segue from technology and the goals of cybernetics and mind - control by the global Wall Street 1% as they MOVE FORWARD ONE WORLD FOREIGN ECONOMIC ZONES----to discussions of health care policy. We alluded to LSD studies and the evidence-based fact that these studies often led to SCHIZOPHRENIA in some patients---psychotic breaks. Here in Baltimore we hear our homeless shelter citizens who are told SORRY, WE ONLY HAVE CUBED SUGAR for your morning coffee say to one another ----DON'T USE THAT CUBED SUGAR IT IS DRUGGED ----THEY ARE EXPERIMENTING ON US-----and indeed that is happening in Baltimore because we have a Baltimore Public Health Commissioner tied to global Johns Hopkins and absolutely no oversight and accountability in what is a completely deregulated, profit-driven, predatory health environment also tied to CIA ONE WORLD ONE GOVERNANCE cybernetics research.

As this article states in Canada---here is Toronto the UK version of our US global Wall Street neo-liberalism stating what is true in the US. The problem is this: good people brought down on their luck through criminal and corrupt city, state, and national global Wall Street pols are the ones falling victim to these medical practices by the very 5% to the 1% sociopaths needing mental health interventions.

When we read a media article about the rising homeless population and hearing about all that mental illness especially SCHIZOPHRENIA we must be thinking to ourselves----this is not natural progression of mental breakdown this is often tied to MOVING FORWARD ONE WORLD VIRTUAL REALITY.

Of course these patients diagnosed with schizo personality then just have to be treated with LSD THERAPY. Just as filling America's food supply with sugar and fat-filled food products boost health care needs---they are now creating their own mental health needs.

News: Why is schizophrenia on the rise in Canada?

According to a Canadian study published in the journal Psychiatry Research, cases of schizophrenia are on the rise in Canada, and the rate of illness is already significantly higher than the average for the rest of the world. The study's author, Marie-José Dealberto, a Queen's University psychiatrist, analyzed a series of smaller studies to […]Best Health

According to a Canadian study published in the journal Psychiatry Research, cases of schizophrenia are on the rise in Canada, and the rate of illness is already significantly higher than the average for the rest of the world.

The study’s author, Marie-José Dealberto, a Queen’s University psychiatrist, analyzed a series of smaller studies to come up with a country average, and found 3.86 of every 1,000 Canadians to be suffering from schizophrenia, while the global rate outside of Canada is just 2.55 per 1,000 people. (No other conclusive national statistics on the prevalence of schizophrenia in Canada currently exist).

The explanations behind the study’s results are somewhat surprising. One theory suggests that schizophrenia is linked to a deficiency in vitamin D. (According to a recent report from Statistics Canada, vitamin D blood levels have declined among Canadians in the last two years.) A second theory points to Canada’s large population of immigrants as a contributing factor. Undergoing such a major life change, while also possibly being subject to racism and other forms of discrimination is a risk factor for the illness,Dr. Kwame McKenzie, a schizophrenia expert at Toronto’s Centre for Addiction and Mental Health, told the National Post.

Are you surprised by the results of this study?

_____________________________________Hmmmm, the same period of LSD research sees schizo symptoms soaring. I'm not a rocket scientist but I can add 2 + 2 to get 4.

Obama and Clinton neo-liberals heavily funded mental health especially addiction ---created policies to release hundreds of thousands of prisoners tied to drug convictions with the stipulation they enter these mental health programs often tied to these CIA mind-control experiments. Obama was not working for WE THE PEOPLE----he was working for that global Wall Street 1% and all of Baltimore's pols are tied to installing these health and technology policies.Who funded that Affordable Care Act provision making sure much of that funding went to global IVY LEAGUES and their BIOTECH facilities? MIKULSKI AS HEAD OF CONGRESSIONAL SENATE APPROPRIATIONS COMMITTEE----who does the same in Maryland Assembly with Maryland health care funds? MAGGIE MCINTOSH ---the favorite of MIKE AND MIKE ----the forever leaders of Maryland Assembly.

'Danish and Australian researchers find, in a review of the Danish Psychiatric Central Research Register, that the incidence rate of early-onset schizophrenia diagnoses has increased significantly in the period from 1971 to 2010',

These program policies start with Congressional laws passed, Congressional funding----then our state and local government SHOULD PROTECT WE THE PEOPLE from bad policy but they don't because they are all global Wall Street players. A Governor O'Malley and now Governor Hogan ---same global Wall Street players----appoints to state health and hygiene a leader tied to MOVING FORWARD CYBERNETICS AND MIND-CONTROL POLICIES along with global telemedicine. Who should be enforcing PATIENT'S BILL OF RIGHTS AND PROTECTIONS? That would be Federal Health and Human Services which under CLINTON/BUSH/OBAMA does not enforce Federal laws to protect citizens---it only works to maximize health industry profits and expand health systems globally.

Of course these CIA/military studies continued widely overseas in Foreign Economic Zones because there are no HIPPOCRATIC OATH----no DO NO HARM ---now we hear mental health crises are global with schizo being that rising fastest----

OH, WELL WE NEED TO DO THAT LSD THERAPY!

View issue TOC Volume 127, Issue 1January 2012Pages 62–68Changes in the diagnosed incidence of early onset schizophrenia over four decades

Objective: To explore changes in the diagnosed incidence of early onset schizophrenia (EOS) from 1971 to 2010.

Method: Examination of incidence rates of schizophrenia in patients under 18 years of age, using a nationwide, population-based, mental health register.

Results: The age-standardized incidence rate (IR) of EOS in the period 1971–2010 was 3.17 (95% CI: 3.16, 3.18) per 100 000 person years in the age group 0–18 years, and 9.10 (95% CI: 9.00, 9.21) in the age group 12–18 years. In the period 1971–1993, the age-standardized IR of EOS was 1.80 (95% CI: 1.79, 1.82) per 100 000 person years in the age group 0–18 years, and 5.02 (95% CI: 4.92, 5.11) in the age group 12–18 years. In the period 1994–2010, the age-standardized IR of EOS was 5.15 (95% CI: 5.10, 5.20) per 100 000 person years in the age group 0–18 years, and 15.73 (95% CI: 15.22, 16.22) in the age group 12–18 years. The IR was higher for males than females in the periods 1971–1993 and 1971–2010, but in the period 1994–2010 the IR was higher for females than males.

Conclusion: In recent years, the diagnosed incidence of EOS has increased and the usual male excess has disappeared. The changes in IR could be a result of changes in the diagnostic system, increased awareness of early psychosis or a reflection of actual underlying incidence of the disorder.

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Since Kermit Cole is a grad of HARVARD psychology and is tied to NEW MEXICO and does not mention these LSD studies by global IVY LEAGUEs during CLINTON/BUSH/OBAMA we appreciate the article below but question why he leaves out the GORILLA-IN-THE-ROOM of early incidence SCHIZO.

Changes in “Schizophrenia” Incidence Over Four Decades

ByKermit ColeAugust 25, 2012Danish and Australian researchers find, in a review of the Danish Psychiatric Central Research Register, that the incidence rate of early-onset schizophrenia diagnoses has increased significantly in the period from 1971 to 2010, and that the higher incidence of the diagnosis in males seen earlier in the period has reversed. The authors draw no conclusions as to whether the changes over the time period reflect changes in the diagnostic system, increased awareness of early psychosis, or changes in the actual incidence of the disorder.____________________________________________Federal funding of mental health could be a good thing IF those institutions receiving the funding had REAL PUBLIC INTEREST mental health policy to install and not simply GLOBAL MENTAL HEALTH PHARMA tied to research to expand cybernetics and artificial intelligence.

Please do not participate in these kinds of studies---know that our most vulnerable populations from ex-felons to homeless are being automatically tracked into these programs. It will not as a policy stay with the low-income---these are societal structures with goals of systematic implementation in SMART CITIES.

Using those Federal funds for REAL mental health programs would rebuild the holistic community-based programs using natural means of treatment----wellness without PHARMA.

The Affordable Care Act will provide one of the largest expansions of mental health and substance use disorder coverage in a generation. Beginning in 2014 under the law, all new small group and individual market plans will be required to cover ten Essential Health Benefit categories, including mental health and substance use disorder services, and will be required to cover them at parity with medical and surgical benefits. The Affordable Care Act builds on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, or the federal parity law), which requires group health plans and insurers that offer mental health and substance use disorder benefits to provide coverage that is comparable to coverage for general medical and surgical care. While almost all large group plans and most small group plans include coverage for some mental health and substance use disorder services, there are gaps in coverage and many people with some coverage of these services do not currently receive the benefit of federal parity protections. The final rule implementing the Essential Health Benefits directs non-grandfathered1 health plans in the individual and small group markets to cover mental health and substance use disorder services as well as to comply with the federal parity law requirements beginning in 2014.2

We saw in that JUSTIN TIMBERLAKE music video our aging married couples looking in the mirror and seeing themselves as a young married couple. That is what virtual reality mind-control does and it is viewed as a positive therapy for ordinary mood changes that are simply normal sadness or depression. When we watch AFFORDABLE HEALTH CARE reform create new ways to handle our aging populations with an emphasis on HOSPICE we already know those installed by a global Wall Street health system ----like Johns Hopkins ----will have these mental health therapies deemed as evidence-based good for WE THE PEOPLE. Having the policy of seniors staying in their homes---most seniors living cheaply in apartments tied to what will be telemedicine and virtual reality is NOT what the American people want.

If all this was good for the 99% of citizens we would hear all kinds of public discussions on these health system policies but instead all discussions are behind closed doors between the very global Wall Street health industry executives now charges with writing our health policies. Of course these polices make up most of preventative care for our low-income but will expand to 99% of US citizens.

Will seniors be anxious and depressed as they lose their retirements, Social Security, strong Medicare----their home-ownership to massive corporate and Wall Street frauds often by the very health institutions now in charge of health policy? YES, that's only natural.

Nearly one in five older adults in America has at least one identified mental health concern (Centers for Disease Control and Prevention and National Association of Chronic Disease Directors, 2008; Eden et al., 2012). Some of the most common disorders diagnosed among this population include depression, anxiety, and cognitive impairment. Depression alone affects more than 6.5 million of the 35 million Americans older than age 65 (Centers for Disease Control and Prevention and National Association of Chronic Disease Directors, 2008). Given that the number of adults older than age 65 is projected to surge from 40.3 million in 2010 to 72.1 million by 2030, the incidence of mental health diagnosis among older adults will have profound implications for the mental health system (Eden et al., 2012).

The mental health needs of older adults long have been neglected in the United States. The healthcare workforce is largely unprepared, in numbers and expertise, to confront the specific mental health needs of our aging population (Eden et al., 2012). Even clinicians lacking training in geriatrics have been unable to provide adequate mental health services to our aging population due to a long history of disparity in insurance coverage for physical and mental health treatments. The Affordable Care Act (ACA), though not a panacea, provides an opportunity to bolster a broken mental health system that disproportionately ignores the needs of older adults.

Expanding Insurance Coverage

The ACA includes a variety of provisions to effect the biggest expansion of mental health and substance abuse services in a generation. The first is the proliferation of health insurance coverage through the Health Insurance Exchanges (HIE) and state-specific Medicaid expansions, which will dramatically expand coverage for those not eligible for Medicare. Early estimates indicated that the overall rate of uninsured residents in the United States would drop by nearly 50 percent following full implementation of the ACA (Kenney et al., 2013). Given the high level of controversy around the interpretation of enrollment numbers following the close of the ACA’s first enrollment period, it is too soon to determine the accuracy of such assessments. However, White House estimates of 8 million enrollees in HIEs and 3 million in Medicaid expansion programs indicate that the ACA already has had a profound effect on national coverage rates (Holst, 2014). The U.S. Department of Health and Human Services estimates that more than 2 million of the new HIE enrollees are older than age 55 (ASPE Office of Health Policy, 2014).

In addition to expanding avenues for obtaining affordable healthcare coverage, the ACA also prohibits insurance companies from denying coverage to people with pre-existing conditions. This change will benefit many people who were previously locked out of the private market, including those who had been excluded because of a documented mental health diagnosis (Mechanic, 2012). This is significant, as mental health disorders were some of the most common pre-existing conditions instigating health insurance denials prior to the full implementation of the ACA (U.S. Government Accountability Office, 2012).

Improving Mental Health Coverage and Access to Care

The ACA also contains many provisions aimed specifically at improving coverage for mental health services. Most private insurance plans must now offer a variety of free preventive services without charging a copayment or coinsurance. This is true even if a patient has not met his or her annual deductible. The two covered services most relevant to mental health care are alcohol misuse screenings and counseling, and depression screenings (U.S. Department of Health and Human Services, 2010). While Medicare is not subject to the same requirements, new rules also have expanded coverage for preventive screenings for this population. Medicare beneficiaries now are entitled to an initial “Welcome to Medicare” wellness exam during the first year of enrollment. They also are eligible for annual follow-up exams. Both types of exams must be provided at no cost to the patient. Depression screenings are included in both of these exams, as well as screenings for cognitive impairment (Hughes, 2011).

One of the most sweeping changes in the ACA is the expansion of the Mental Health Parity and Addiction Equity Act (MHPAE) of 2008. While the 2008 law represented a significant step forward in requiring coverage for mental illness to be comparable to that for physical ailments, there were many holes. MHPAE did not mandate mental health coverage; such coverage only applied to plans that had already opted to provide some mental health coverage. The ACA, in contrast, identified mental health and substance use treatment as one of the ten “essential health benefits” for all health insurance plans in the individual and employer market—inside and outside HIEs. While many states have developed their own, more inclusive parity laws over the years, these rule changes represent the first time that federal law has mandated mental health and substance use treatment coverage.

In addition to mandatory coverage of mental health services, the ACA also fills in other gaps in the earlier parity law. The new rules clarify, for instance, that parity must be applied at all treatment levels, including intermediate settings that do not fall neatly into inpatient and outpatient categories. Also, the ACA specifies that insurance plans must be consistent across treatments for physical and mental illness when considering what is “medically necessary” (Carrns, 2014).

While these new parity rules under the ACA are more comprehensive than their predecessors for regulating private health insurance,they do not apply directly to public health plans such as Medicaid and Medicare. Fortunately, other rules are being considered to ensure greater parity in these programs.

In July 2008, Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA), aimed at ending the discriminatory mental health coverage that had previously required patients to pay for up to 50 percent of approved services, as opposed to the 20 percent copayment that applied to other types of outpatient services. This law phased out the coverage disparity over five years. As of January 2014, there is 100 percent parity in copayments for outpatient services, which means that while Medicare previously only covered 50 percent of outpatient services, they will now cover 80 percent, as they do with other kinds of outpatient services (Graham, 2013).While MIPPA represents a step forward for mental health coverage for Medicare beneficiaries, disparity still exists. There remains a 190-day lifetime limit on inpatient stays in psychiatric units. No such cap exists for any other kind of inpatient service. This arbitrary limit has significant implications for those with chronic or serious mental health conditions that require ongoing treatment and care. It also disproportionately affects younger and poorer Medicare beneficiaries, as a majority of Medicare patients treated in psychiatric facilities qualify because of disability. In 2008, 65 percent of discharges from inpatient psychiatric facilities were for beneficiaries younger than age 65 (National Association of Psychiatric Health Systems, 2013).

More advocacy is needed to bring Medicare mental health coverage in line with that of private insurance. However, this alone will not solve the problem of inadequate access to mental health services for Medicare beneficiaries. Older adults present with unique psychosocial and biological challenges that generalists often are ill-equipped to address, and there are not enough psychologists, social workers, and psychiatrists with advanced geriatric training to meet current (and rising) demand (Jeste et al., 1999). Psychiatric specialization in geriatrics requires an additional one-year fellowship. During the 2011–2012 academic year, there were only fifty-eight geriatric psychiatry fellows in the country. Advanced geriatric training opportunities are similarly limited for psychologists and social workers (Eden et al., 2012).

Another barrier to treatment not addressed by healthcare reform is the unwillingness of certain mental health providers—namely psychiatrists—to accept Medicare payments. A recent study published in JAMA Psychiatry revealed that in 2010 only 54.8 percent of psychiatrists accepted Medicare (as opposed to 86.1 percent among other specialties). One reason is inadequate reimbursement rates by insurers. Another is that the psychiatrist supply is not increasing as quickly as demand (Bishop et al., 2014). As demand increases, psychiatrists can command more money for the same service and may not need to accept insurance (Grohol, 2014). This situation is unlikely to change unless Medicare updates the way it reimburses psychiatric services. If a majority of psychiatrists is unwilling to accept Medicare, this leaves many older adults without access to vital mental health services.

In spite of the Obama Administration’s stated commitment to improve access to mental health care, advocacy groups have had to remain vigilant to see this vision realized. In January 2014, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule that would have severely restricted Medicare Part D coverage of antidepressant and antipsychotic medications. This rule would have reduced available antidepressants and antipsychotics from fifty-seven to about fifteen, according to one pharmaceutical industry group (Jan, 2014).The goal of the proposed rule was to save money by eliminating coverage for more expensive drugs and pushing physicians to prescribe lower cost or generic alternatives. Opponents argued that such restrictions posed risks to vulnerable elders. While most people living with a mental illness will respond to most medications within a certain class or category, approximately 20 percent will not, and there is no good way to identify these patients (National Alliance on Mental Illness, 2014). CMS ultimately bowed to pressure from industry stakeholders, patient groups, and lawmakers by dropping the proposed rule in March 2014.

Community Health Centers

Health Resources and Services Administration (HRSA)–supported health centers have been operating for forty-five years to provide primary care services to underserved communities, regardless of patients’ ability to pay. As of 2012, 7 percent of the 21 million health center patients were older than age 65. The ACA established the Community Health Center Fund, which provides $11 billion to expand services offered in Community Health Centers and construct additional sites. Behavioral health treatment was on the optional list of services that centers could expand using money from this pool (HRSA, 2013). In June 2014, an additional $300 million dollars was made available to further expand services at existing centers. Again, behavioral health services were included as optional targets for the new funds (HRSA, 2014). How many centers will direct these funds toward mental health remains to be seen. However, the money potentially could provide access to mental health treatment in areas where such services are typically scarce. Increasing capacity in these communities is especially crucial in light of the fact that many more vulnerable people will now have access to insurance.

These health centers may serve as important resources for undocumented immigrants, whose access to healthcare was not otherwise improved by the ACA. In 2007, 57 percent of undocumented immigrants were uninsured. That number is not likely to change under the ACA. Not only are undocumented immigrants locked out of public health programs such as Medicare and Medicaid, they also are unable to purchase insurance from the Health Insurance Exchanges. HRSA-supported health centers have been a vital source of medical care for all ages within this population. Going forward, hopefully they also will be an increasingly robust resource for mental health care.

Care Coordination and Mental Health Integration

Another of the ACA’s central objectives is to encourage greater care coordination and integration of physical and mental health services. Service integration is particularly vital for older adults in the primary care setting, as it presents important opportunities for detecting and treating mental health disorders. Approximately one-third of older adults in primary care settings have significant mental health symptoms. Many of these symptoms go unrecognized and untreated (Bartels, 2003). This represents a missed opportunity and serious public health risk, as several research studies have shown that geriatric depression can be treated effectively in primary care settings when mental health providers are available for consultation and treatment. Further, many older adults prefer to receive mental health treatment in a primary care setting because of the perceived stigma associated with traditional psychiatric settings (Oxman, Dietrich, and Schulberg, 2005).

Another argument for integrating physical and mental health services is that physical and mental illness are not mutually exclusive. Depression is often comorbid with other chronic diseases and can negatively affect adherence to treatment (Moussavi et al., 2007). A 2001 metaanalysis found that 11 percent of those diagnosed with diabetes met criteria for Major Depressive Disorder (with another 31 percent presenting with clinically significant depressive symptoms) (Anderson et al., 2001). Non-adherence to diabetes treatment is closely associated with depression (Bell et al., 2010). While there is still a “chicken or egg” situation when it comes to determining the direction of causality between depression and diabetes, the interactive nature of these two diseases illustrates the need for integrating healthcare for mental and physical illness in order to maximize treatment outcomes.

Accountable Care Organizations

The ACA contains a variety of provisions to promote integrating mental health and primary care. One such provision is in the creation of Accountable Care Organizations (ACO), which incentivize doctors, hospitals, and other healthcare providers to establish networks that coordinate care for Medicare patients. Providers then become eligible for bonuses if they can demonstrate that care was delivered more efficiently. This model is in line with the ACA’s “whole person” philosophy, in which providers take responsibility for a patient’s overall well-being— both mental and physical. It also represents a move to incentivize a higher quality of care and better health outcomes over the quantity of procedures performed or interventions delivered. Put simply, providers get paid more money to keep their patients healthy. ACOs already have an enormous presence in the healthcare industry: about 4 million Medicare beneficiaries are now in an ACO (Gold, 2014).

Unfortunately, chronic care management and integrated mental health care have not been specifically addressed in the ACO model, despite the ACA’s emphasis on holistic, integrated care. The only measure relating explicitly to mental health under CMS regulations for ACOs is a mandatory screening for depression, coupled with documentation of a follow-up treatment plan. This alone may lead to better outcomes of patients with mental health concerns. However, the lack of specific mental health provisions in the rules represents a serious deficiency in the true integration of comprehensive mental health care (O’Donnell et al., 2013). As of 2012, 36 percent of ACOs had no formal relationship with a mental health provider (Citters et al., 2013).

One of the barriers to full integration of mental health services within the ACO framework is financial. Although ACOs allow for shared savings when care is delivered efficiently, they still are fundamentally rooted in a fee-for-service model. This model acts as a disincentive to investment in non-billable care coordination and mental health services that are essential to the ACA’s goal of treating the whole person. With no money allocated by the ACA to reimburse the services of care managers and social workers, coordinating care and integrating services will remain elusive.

Alternatively, other financial models could be considered that incorporate economic incentives for integrated care, such as bundled payments, pay-for-performance, and gain-sharing (Eldridge, 2011–2012). New organizational models for mental health integration must also be explored. Many alternative, evidence-based models already exist that are structured to support integrating mental health care into primary care, such as Ambulatory Integration of the Medical and Social (AIMS) (Agency for Healthcare Research and Quality, 2014) and Primary Care Behavioral Health (PCBH) (Robinson and Reiter, 2007).

Medicaid health homes

The ACA also includes provisions to promote care coordination and mental health integration within the Medicaid population. The most notable initiative is the Medicaid “health home,” which targets individuals with multiple chronic conditions and serious mental illness. Under this model, states are authorized to reimburse a patient-designated health home provider who provides care management (Mechanic, 2012). These health homes are designed to be patient-centered systems that aid the coordination of primary and acute physical health services, behavioral healthcare, and long-term community-based services and supports. States opting to participate in the program must offer a variety of mandatory services, including comprehensive care management, care coordination and health promotion, comprehensive transitional care, and referral to community and social support services (Kaiser Family Foundation, 2011). So far, CMS has approved Health Home State Plans in fifteen states (Kaiser Family Foundation, 2014).

Dual eligible alignment initiatives

A third initiative aimed at greater coordination and integration of services targets the 9 million beneficiaries considered “dual eligible” (eligible for both Medicare and Medicaid). This group represents some of the sickest and most economically vulnerable individuals in the country. The financial and regulatory misalignment between the two major payers historically has left patients with a complicated system to navigate and providers with limited incentives to coordinate care. The ACA provides a variety of new options to improve and integrate care for patients who are dually eligible. Approved states will be experimenting with two models of payment alignment for dual eligible individuals: a capitated model and a managed fee-for-service model. To date, CMS has approved fifteen state plans to design new approaches for Medicare and Medicaid coordination. A total of thirty-seven states and the District of Columbia have submitted letters of intent to participate in alignment initiatives. These initiatives not only seek to align the programs financially, but also to promote integrating primary care, acute care, long-term services and supports, and behavioral health.

Having one healthcare entity responsible for the coordination of a patient’s physical and mental health care may provide significant opportunities to promote holistic, integrated care among one of the country’s most vulnerable populations (Walls et al., 2013). Only time will tell whether or not these state-based plans will improve patient outcomes.Conclusion

The ACA and other recent changes to healthcare policy provide us with a historic opportunity to transform a fragmented and inadequate healthcare delivery system, especially when it comes to providing mental health and substance abuse services. Such changes have significant implications for older adults, whose mental health needs have long been neglected. Expansion of insurance coverage, the establishment of essential benefits, and experimental financial and organizational delivery models have the potential to dramatically improve access to vital mental health services for all Americans, and older adults in particular. However, continued advocacy is needed to ensure that the promises of greater access and more complete integration are realized. Clinicians, researchers, and policy makers will need to be vigilant in monitoring the rollout of these reforms to see that they are executed in effective, sustainable, and socially just ways. More work also must be done to secure full funding for the initiatives established by the ACA, lest they remain nothing more than good ideas. We cannot miss this important opportunity to bring “whole person” care to the center of our national healthcare system._____________________________________________

There was a reason most Republican states signed on to expanded Medicaid. First, it is the right wing UNIVERSAL/SINGLE PAYER policy----preventative care only. It happens to be that global ONE WORLD UNITED NATIONS ONE WORLD HEALTH policy as well. Indeed, globally these same mental health/hospice policies are being installed. Since these several years of Obama staged the massive US Treasury bond frauds taking the US to $20 trillion in national debt there was no plan to see these Medicare/Medicaid programs funded---what is planned is a global World Health implementation and control of health care in the US as abroad with funding coming from global hedge funds.

So, as with FEED THE CITY as this coming economic crash takes US to extreme poverty from long-term Depression/Recession -----FEED THE CITY is funded by global hedge funds so too will be these health policies funded by WORLD HEALTH-----and US health care will look like Malaysia, China, Vietnam, Singapore, Peru, ---all those FOREIGN ECONOMIC ZONES.

FEED THE CITY replaces our once US Federal Food Stamp safety net------WORLD HEALTH will replace our once Federal Medicare/Medicaid safety net. So, it does not matter if Congress funds these programs or not----the goal is ending all Federal connections to health care and handing all to WORLD HEALTH and yes, they are tied to these mental health SMART CITY mind-control virtual reality policies.

Please think about these policies longer term---if they are indeed helping some citizens ---often these mental treatments are placebo-driven ----many medical professionals are calling the claims to alcohol and drug addiction PHARMA unreliable and indeed placebo-effect. As global Wall Street pols stage for an economic crash to take Americans deeper and more broadly into poverty ----which heightens mental health and drug abuses---they are creating the conditions they pretend they are trying to help.

The estimate from the Committee for a Responsible Federal Budget includes the repeal's effect on the economy. Video provided by Newsy Newslook(Photo: Family photo)

Sherri Reynolds' son Qual has been drug free for 16 months, thanks in large part to treatment he got through Medicaid under the Affordable Care Act.Reynolds knows firsthand what can happen when people can't get coverage: Her 20-year-old stepson, Jarvis, suffered from mental illness and killed himself in 2010 after he couldn't get medical treatment. He bounced in and out of foster care and the juvenile justice system.

“I really hope they don’t dismantle Obamacare and I don’t understand why they would dismantle something which is credited for saving so many lives," says Sherri Reynolds.As Congress works to repeal the Affordable Care Act with the support of President-elect Donald Trump, people with addiction and mental health disorders, their families and treatment providers wonder how patients would maintain their sobriety — and psyches — without insurance coverage.

The people helped the most by the ACA are the ones most likely to suffer from poor mental health and addiction. Nearly 30% of those who got coverage through Medicaid expansion have a mental disorder, such as anxiety or schizophrenia, or an addiction to substances, such as opioids or alcohol, according to the federal Substance Abuse and Mental Health Services Administration. That compares to the more than 20% of the overall population — 68 million people — who experienced a diagnosable mental health or substance abuse disorder in the past year, the American Psychiatric Association says.

In New Hampshire, which has the highest synthetic opioid death rate in the country, Democratic Sen. Jeanne Shaheen is reminding Trump about some of his campaign promises in her state.

"He pledged to take on this crisis, not immediately make matters much worse," Shaheen said in an email Friday. "Repealing the Affordable Care Act without a replacement is highly reckless and will come at a high cost for people struggling with substance use disorders.”

Almost any route taken on Capitol Hill leads to an unraveling of addiction and mental health.coverage for these people. Even the partial ACA repeal Congress is considering would eliminate the tax credits that reduce the premiums for about 85% of those who buy insurance on the federal and state exchanges. Most of those who get tax credits pay less than $100 a month for insurance and have very low out-of-pocket costs that make it possible for them to afford coverage.

The partial repeal would also scrap the expansion of Medicaid that gave millions of the lowest-income people in 31 states insurance. Instead, states would most likely get block grants that would require them to make cuts in what's covered, how much is spent and how many people can get coverage. States might instead get a set amount per person, which would also lead to cuts as the overall goal is cutting spending.

If the same legislation passed by Congress but vetoed by President Obama a year ago was enacted, people would still be able to keep their children on their insurance until age 26 and insurers wouldn't be able to discriminate against people who have preexisting health conditions, such as depression or cancer. It also retains the "essential health benefits," including mental health and addiction coverage, now required for all plans sold on the federal and state exchanges.

Without the ability to pay for insurance, however, some say that otherwise hopeful sign would carry little significance."Some families will do what they have to do to help their loved ones," says Amanda Fleckinger, a former heroin addict in Edgewood, Ky., who lost her brother and boyfriend to overdoses in the last 18 months. "If there’s no coverage, I think we would definitely see an increase in deaths."

A 2008 law that required insurers to cover mental health and addiction at the same level they do other diseases is "useless" if there's no insurance coverage for low income patients that has to reach parity, says Linda Rosenberg, CEO of the National Council on Behavioral Health. She describes the current debate on Capitol Hill over the ACA's future as "the most critical time" in her 40-year career as a social worker.Medication-assisted treatment for addiction "has really come into its own," she says. "There's been tremendous progress."

Former Rep. Patrick Kennedy, D-R.I., who wrote the mental health and addiction parity law, says it wasn't his law but the ACA that "made the greatest difference.""It was the best mental health and addiction bill ever," he said. "It takes our mandates and makes them real for more people."

A lot of the mental health programs developed by the Montefiore Health System in the Bronx are contingent upon patients getting early treatment in primary care, says psychiatrist Henry Chung, chief medical officer of Montefiore’s care management organization.

Critical new mental health provisions in the recently enacted 21st Century Cures Act that improve access to treatment need "to be combined with strong, affordable insurance," says Chung. "You can’t have one without the other or some of that progress will be taken away," he says.

Among areas that would be hard hit:

• New Hampshire.

Repealing the ACA would cause nearly 120,000 people to lose coverage in New Hampshire, where federal data shows a nearly 200% increase in overdose deaths in the last five years. Treatment is already insufficient in the state. Stripping away health insurance coverage from thousands of residents through ACA repeal would make treatment that much more inaccessible and unaffordable, Shaheen says. According to her office, more than 48,000 Medicaid claims were submitted for substance use disorder in 2015. The ACA also reduced the strain on hospitals and treatment providers in the state by allowing more patients to get treatment without going to the emergency room, Shaheen says. The senator has visited more than 30 treatment centers in New Hampshire over the last year, which she says convinced her that repealing the ACA is "literally a matter of life and death.”

• Ohio.

At the Cincinnati Center for Addiction Treatment, CEO Sandra Kuehn said she saw a huge uptick in the number of men seeking help after Medicaid was expanded to all adults under 138% of the federal poverty limit. Before states could expand Medicaid under the ACA with a large federal match, Medicaid eligibility varied widely and typically only covered women who were pregnant or had young children (along with the disabled and many seniors with very limited resources). About 30% of Kuehn's patients are covered for treatment because of the expansion, she said. Overdose deaths climbed from 2,531 in 2014 to 3,050 in 2015, a more than 20% jump. That included a sharp increase in overdose deaths related to the powerful synthetic opioid fentanyl, from 503 in 2014 to 1,155 in 2015, according to the Ohio Department of Health.

• Kentucky.

Overdose deaths here totaled 1,248 in 2015, up about 17% from 2014, according to the Kentucky Office of Drug Control Policy. Fentanyl — which is much stronger than heroin — was involved in 420 fatal overdoses in 2015 in Kentucky, up nearly 250% from the previous year. The drug caused 34% of all overdose deaths in the state, frequently in combination with heroin or other drugs, the report states. Fleckinger isn't surprised. At just 25, she is amazed at how in the time since she was in high school, it has gone from where young people were drinking "and having fun" to wanting to get "totally wasted" and often overdosing. She knows several people who have overdosed and many others who have died — including one in the last week.

• Chicago.

The Cook County jail here is often referred to as the largest mental health facility in the country. Up to 30% of the 9,000 or more inmates in the jail have a diagnosed mental illness, according to jail data."The ACA has been a game changer for those who are in and out of Cook County Jail," says Mark Ishaug, CEO of Thresholds, a community-based mental health and addiction services provider in Chicago. He says poor people of color, especially single men, were finally able to keep health coverage once they left the jail. It costs less than $20,000 a year for Threshold's highest level of community-based mental healthcare with a housing voucher, compared to nearly $70,000 a year to keep the patients in jail. About a third of Threshold's 15,000 clients became eligible for coverage through the ACA.

Amanda Fleckinger’s parents paid thousands of dollars for her heroin treatment program before the Affordable Care Act took effect in 2013. By the time her brother Brian was struggling with heroin addiction in 2015, Kentucky had expanded Medicaid coverage and he could get treatment. So could her boyfriend.

When her brother and boyfriend were alive, Fleckinger's concerns centered on what medication-assisted treatment their Medicaid plan would cover. Waiting "one day for a addict is too long," she says. But at least she knew they could get coverage for some type of treatment, she says.

It wasn't enough to keep her boyfriend Neil alive, however. He died in August of an overdose of carfentanyl, an opioid so strong that it is used as an elephant tranquilizer. Fleckinger was nine months pregnant with Neil's baby at the time of his death. As she raises baby Carter alone, she wonders how things changed so quickly and that it's "not unheard of for kids to try this stuff even as young as in high school."With an Obamacare repeal looming, Sherri Reynolds worries what will become of her son, Qual, whose slide into mental illness and addiction began after Jarvis killed himself.

"He was 20, and for his birthday, we got him a tombstone," Reynolds says of Jarvis.By the time she realized Qual needed mental health and addiction treatment, he was reaching the age when her insurance coverage would no longer cover him. But in 2015, Medicaid was available to Qual in Kentucky and he got the help he needed. For the past year, it has covered an injectible medication, naltrexone, that blocks the effects of opioids

Chung at Montefiore worries that if Congress leaves what plans cover up to states — and individuals — people won't choose correctly as "people don’t know they are at risk of a mental health condition.""I hope Congress will recognize that you can’t go back on this," says Chung._________________________________________Here is SINGAPORE tied to the same World Health policies for all those global citizens who are seeing soaring MENTAL HEALTH DIAGNOSES.

For those middle-class citizens set to be pushed into poverty---WORLD HEALTH has its eyes on you as well. So, what kind of care will our citizens still affording private health insurance receive? Well, a decade or two of using our low-income as research will lead to the same telemedicine, virtual reality treatments. The only citizens able to access what is ordinary Western standards of health care will be that global 1% and their 2%---

Whether trapped in global labor pool and global sweat shop factory living or whether being sent to planetary mining colonies-----MOVING FORWARD is tied to making WE THE PEOPLE as malleable and cheaply contained in sickness and health.

Budget 2017: More support for people with disabilities and those with mental health conditions

SINGAPORE: The Government will provide more support for people with disabilities and those with mental health conditions in this year’s Budget. In his Budget statement delivered on Monday (Feb 20), Finance Minister Heng Swee Keat emphasised the need for everyone to build an inclusive society.

“All of us can play a part in our communities,” he said. “All of us have something to offer, be it time, expertise or the extra attention, to care for each other.”

To that end, he announced a number of initiatives aimed to help those with disabilities and mental health conditions.

WHO Mental Health Gap Action Programme (mhGAP)

Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected - 75% in many low-income countries - do not have access to the treatment they need.

The WHO Mental Health Gap Action Programme (mhGAP) aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income. The programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives– even where resources are scarce.

The link below will also take you to resources, reports and the mhGAP newsletter. The information is to help reduce the mental health treatment gap.

_____________________________________________

If you are global Wall Street getting ready to bring our first world developed nations in Europe and North America down to third world conditions regarding quality of life and extreme wealth inequity as exists in ONE WORLD ONE GOVERNANCE FOREIGN ECONOMIC ZONES-----your idea of EVIDENCE-BASED medicine tied to protecting corporate profits and the wealth of global 1% is to get ahead of these increasing and deepening poverty and the depressions, anxieties, the growing black market economies tied to more drug dealing and addictions -----creating the cheapest vehicle for handling the 99% ----that is what Affordable Care Act and its mental health policy is building. The LEFT SOCIAL DEMOCRATIC stance on mental illness is GETTING CITIZENS OUT OF POVERTY AND LIVING STABLE LIVES=====the far-right wing global Wall Street stance on mental illness is continue extreme wealth and extreme poverty but find a platform to cheaply contain a growing unstable society. That is what mental health by PHARMA, telemedicine, and virtual reality does.

WHAT HAPPENS AS ROBOTICS AND DESIGNER ECONOMY KILLS MOST EMPLOYMENT FOR THE AMERICAN PEOPLE? MENTAL HEALTH DECLINES.

Mental illness and poverty: you can't tackle one without the other

A recent report recommends dealing with mental illness before poverty, but this overlooks the fact that the two are fundamentally linked

You rarely get homeless people asking if you have any spare antidepressants. There are good reasons for this. Photograph: Andy Clark / Reuters/REUTERS

For the record, I’ve no issue with Lord Layard, and I’ve no doubt that his intentions are honourable and intended to be helpful. It is also the case, without question, that the UK government should indeed invest significantly more in mental healthcare, given the dire state it’s currently in.

However, this report and the recommendations it makes have angered many in the mental health community, and with good reason. The report seems to treat mental health issues and poverty as separate things, occasionally overlapping perhaps but with their own distinct effects and mechanisms that don’t really impact on each other. However, anyone involved in mental healthcare will tell you that this is a farcical claim when faced with the reality of the situation.

Lord Layard has stated that mental illness is a bigger cause of misery than poverty in our society. But as any credible psychologist will tell you, this is like saying bacteria is a bigger cause of cholera than dirty water; even if technically true, they’re both aspects of the same problem, and by focusing solely on one you’re never going to really deal with it.

It would be unreasonable to expect this person to be cheerful about his predicament, and a few therapy sessions wouldn’t really be much use in dealing with that.

The causes and triggers for mental health problems are many, varied and often poorly understood. There’s rarely just “one” thing that causes them. It can be genetics, trauma, or some other cause of considerable stress. And that’s a key issue: stress.

The stress-vulnerability model of mental health is a neat way of showing that our brains can only handle a certain amount of stress before a crucial threshold is crossed and we end up mentally ill. Some people can handle a lot of stress before a breakdown occurs, others not so much. The amount of stress needed to tip you over the edge depends on many factors, but a major one is how much stress you deal with on a regular basis. Typically, if you’re exposed to stressful things all day every day, your brain’s capacity to deal with it is already being used up, so it doesn’t take a great deal more until you reach breaking point and can no longer cope.

Poverty is a major cause of stress. You can’t pay your bills, buy food, cover the rent, afford to provide for your children, these are all massive causes of stress. Even if you’ve no dependants, just living on the breadline is stressful in itself. The uncertainty caused by not knowing if your job is safe? Stressful. The loss of control over your own life due to lack of certainty and financial resources? Very stressful. Turning to drink or drugs to try and make yourself feel good in spite of your situation? Hugely stressful for you and anyone who care about you. Living in a dangerous, high-crime area because you can’t afford anywhere better? Massively stressful.

These are just a small number of factors that can and do contribute to mental illness, all of which stem from poverty. To argue we shouldn’t focus on it seems extremely naïve to say the least, when you consider all this.

Maybe it’s because those involved in the Layard study are all economists, that things like this are seemingly overlooked. They’re all extremely clever people no doubt, but some questionable claims stand out, at least in the Guardian’s coverage of it. For example:

…on average people have become no happier in the last 50 years, despite average incomes more than doubling

The “average” income may have doubled, but all the available data shows that income is highly concentrated in the top 20% of the population. Factor in inflation and cost of living increases, and this huge inequality should mean it’s no surprise that the “average” income is meaningless to those on the breadline. You could try explaining to them that the top 10% are considerably richer than them, but how or why this would make them happy is anyone’s guess.

Having a partner is as good for you as being made unemployed is bad for you.

Supposing this is true; how do you get a (presumably romantic) partner? Usually it involves meeting people in social situations, perhaps through friends or colleagues, and then typically dating and getting to know each other better. Even the most basic manifestation of these things requires money to be spent. Working three jobs just to make ends meet does not leave a lot of time and resources available to effectively court someone.

Focusing on mental healthcare is a very valid and undoubtedly urgent suggestion for the UK government. But to do so at the expense of tackling poverty is counterproductive, to say the least.It’s wallpapering over rising damp; everything may look better, but the underlying problem hasn’t gone away and it’s now likely to get even worse.

It could also, however unintentionally, further stigmatise those worse off. It absolves those in power of any responsibility to address wealth inequality, and puts the onus on those with mental health concerns to get help, despite this not being nearly as straightforward as that suggests.

You can’t ignore the links between poverty and mental health problems. Dealing with both would benefit everyone, but as long as we have one we should expect the other.

_________________________________________________I think most Americans understand there is no intent to rebuild an American middle-class and indeed with unemployment soaring the conditions for mental health are set to hit most. We speak to seniors today already struggling to maintain their lifestyles tied to depression and anxiety.

'You can’t ignore the links between poverty and mental health problems. Dealing with both would benefit everyone, but as long as we have one we should expect the other'.

Of course all these health policies will be tied to those pesky pre-K testing of all our children and the vocational tracking of vocational K-career. Along with those educational tests will be testing for health/medical pre-existing conditions. Those global Wall Street CLINTON/OBAMA neo-liberals pretending they care about protecting PRE-EXISTING CONDITIONS---- this article states 20% of population creates the greatest social costs. Know what? Today in the US with unemployment and poverty growing---the single major cause of health deterioration-----we have over 50% of Americans in poverty with another 30% near poverty so that stat of 20% OF POPULATION BEING THE MOST COSTLY is bogus. When poverty in US used to be 10-20% that stat may have been correct but it does not represent what exists today and what conditions will exist in the US in a decade or two.

EVIDENCE-BASED medicine under global Wall Street protects profits and wealth of global 1%----so their health policies are build the cheapest model of preventative care and containment.

This is why it matters just what kind of medical treatments they are unrolling for our mentally ill AND it matters that they expanded the categories of what defines mental illness to what many think are ordinary emotional states.

Can Poverty Lead To Mental Illness?

October 30, 20165:06 AM ETEmily Sohn

Lily Padula for NPR

Goats and Soda

Mother Kills Her Children And Herself; Chinese Bloggers Ask Why

After a mother killed her four young children and then herself last month in rural China, onlookers quickly pointed to life circumstances.The family lived in extreme poverty, and bloggers speculated that her inability to escape adversity pushed her over the edge.

Can poverty really cause mental illness?

It's a complex question that is fairly new to science. Despite high rates of both poverty and mental disorders around the world, researchers only started probing the possible links about 25 years ago.

Since then, evidence has piled up to make the case that, at the very least, there is a connection. People who live in poverty appear to be at higher risk for mental illnesses. They also report lower levels of happiness.

That seems to be true all over the globe. In a 2010 review of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes.

And there's growing evidence that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the "poor but happy African sitting under a palm tree," says Johannes Haushofer, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University.

As data builds to connect tough economic circumstances with mental struggles, scientists are still trying to answer a trickier question:

Which causes which?

There is no easy answer, says psychologist Crick Lund of the University of Capetown, who studies mental health policy. Mental illness is never caused by just one thing. Poverty can be one factor that interacts with genetics, adverse life events or substance abuse.

But so far, the strongest evidence suggests that poverty can lead to mental illness, especially in cases of disorders like depression.Because scientists can't experimentally plunge people into poverty to see what happens to their mental health, natural experiments offer one kind of clue. When disasters or tough spells (like losing a job or enduring periods of drought for farmers) destroy financial circumstances, numerous studies show a rise in rates of depression, Haushofer says.

On the flip side, people often get happier after economic windfalls. In a new study, Haushofer and a colleague found that when families in Kenya were given cash grants averaging $700 (nearly twice the amount typically spent per person per year), they reported higher levels of life satisfaction and lower levels of depression than they did before they got the money, which they could spend on anything. The larger the cash transfer, the bigger the mental boost. It didn't matter if the money came in monthly installments or all at once.

Despite the long-held belief that winning the lottery destroys lives as people make bad decisions about how to use the money, Haushofer adds, newer evidence suggests the opposite. In study published this year, researchers in Sweden, reported that lottery winners used fewer anti-anxiety medications and sleeping pills after collecting their payout, suggesting that they became happier.

So how does poverty "get under the skin" or into the brain, Lund asks? Stress is a leading contender. Some studies have found higher levels of the stress hormone cortisol in people living in poverty. In Mexican households that received cash grants, found a 2009 study, young children had lower cortisol levels compared to kids from families that didn't get extra money. Other studies, however, have failed to find any changes in cortisol.

Rates of violence are also higher among people who face economic tension. Living amid violence can exacerbate depression, Lund adds. And studies have found connections between mental illness and poverty-associated conditions, such as not having enough to eat, not making enough money to live on and having a greater chance of developing risks for physical illnesses.

Mental illness may, in some cases, lead people down a road to poverty, Lund says, because of disability, stigma or the need to spend extra money on health care. may play a role, with some evidence suggesting that poverty more often leads to depression while disorders like schizophrenia more often lead to poverty.

Still unclear is how best to break the cycle. Although cash-transfer programs have shown promising improvements to mental health, studies have yet to determine whether those improvements persist in the long-term."I think the jury is still out on the extent to which poverty alleviation interventions actually lead to mental health improvements," Lund says. "It hasn't been evaluated rigorously enough."

Data is also lacking on whether mental-health interventions can make a true dent in poverty rates or why some people remain resilient even in extremely challenging circumstances.

"We don't know whether intervening in depression is also a good poverty intervention," Haushofer says. Because depression keeps people out of work, treating it should help, but evidence is still lacking.Better data may be coming. Lund is in charge of an effort called PRIME, a multinational consortium that aims to implement treatment programs for mental disorders in low-resource settings. One project involves tracking efforts to improve access to mental health services in five countries, including Ethiopia, South Africa and Uganda, with preliminary results expected within the next year.

In 2013, the World Health Organization committed to a mental health action plan, with a goal of increasing access to services for severe mental health disorders by 20 percent and reducing the suicide rate by 10 percent in 135 member countries by 2020.

As for why the mother in China took the lives of her children, no one can say for sure. Similar tragedies happen in wealthy countries, too.

_____________________________________________

Here is where US citizens need to be aware and political active----the Affordable Care Act tied every American to buying health insurance at the same time it created global health systems tied to EVIDENCE-BASED medical treatments with mega-data compiling everything WE THE PEOPLE do in our lives----such as that SMART HOUSE medicine cabinet that knows if we take our prescription medicine. It will monitor what we purchase in food, drink, alcohol/smoking and all of this will determine whether an insurance rate needs to be higher---whether that insurance plan drops a citizen----AND it places citizens into the position of HAVING TO DO WHAT A DOCTOR PRESCRIBES. You cannot be without health insurance will lead to you cannot chose to ignore medical diagnoses and treatment.

If MOVING FORWARD is tied to TREATING PATIENTS CHEAPLY through containment a citizen told they need PHARMA for mental health et al will be required to follow that treatment. No doubt remote microchip insertion will monitor that treatment.

ALL OF THIS IS ORWELLIAN AND AUTHORITARIAN AND THERE IS NO PATIENT'S BILL OF RIGHTS---NO DO NO HARM---NO HIPPOCRATIC OATH IN SIGHT.

If a primary care doctor states a patient has those mental health symptoms that patient will be tracked into these standards of treatment no questions asked.

'Yet, patients do ignore doctor’s orders, and much more frequently than physicians would care to acknowledge. In 2011, nearly half a million admitted patients, 1 to 2 percent, left American hospitals “A.M.A.” — against medical advice. A 2010 Harvard Medical School study showed that about 20 percent of first-time prescriptions are never filled. According to the Centers for Disease Control and Prevention, fewer than two of three Americans over 50 have received recommended screening for colon cancer'.

It is a problem for doctors when patients do not follow prescribed treatments----health outcomes are determined by patient followup. What we are MOVING FORWARD is far different than that old-fashioned American public health care---we are moving into a very global predatory, profit-driven, deregulated with no oversight and accountability health care and having no ability to say NO TO A TREATMENT is very, very, very, very bad health policy.

In Practice

Why patients don’t always follow doctor’s orders

By Dr. Suzanne Koven Globe Correspondent April 22, 2013

Medicine, as physician and literary scholar Abraham Fuks has pointed out, often borrows language from the military. Patients “battle” cancer, which “invades” bodily tissues, hoping for a “magic bullet.” Similarly, doctors, unlike lawyers, architects, and accountants, give “orders.” The implication seems to be that while a person who rejects advice from any other sort of professional is a discriminating consumer, someone who fails to follow a doctor’s orders is foolish, self-destructive, or even insubordinate.

Yet, patients do ignore doctor’s orders, and much more frequently than physicians would care to acknowledge. In 2011, nearly half a million admitted patients, 1 to 2 percent, left American hospitals “A.M.A.” — against medical advice. A 2010 Harvard Medical School study showed that about 20 percent of first-time prescriptions are never filled. According to the Centers for Disease Control and Prevention, fewer than two of three Americans over 50 have received recommended screening for colon cancer.

Still, when faced with a patient who stubbornly refuses to do what’s so obviously right — i.e. what I tell him or her to do! -- I find myself slipping into that military mentality. Why isn’t the patient following my orders? Is he or she questioning my authority? Have I failed to communicate my orders effectively? Is it the patient’s fault, or mine? Either way noncompliance often leaves me frustrated.

“Frustration” would certainly describe my feelings during the first several years of my relationship with a patient named Paul. He’s a charming and intelligent man, now in his 50’s, whom I first met over 20 years ago. Paul has a strong family history of cardiovascular disease, but he balked at taking medication for his high blood pressure, and often skipped appointments. I didn’t understand why this seemingly reasonable man would act so unreasonably.

I was even more mystified when, about five years ago, Paul developed diabetes and continued with his noncompliant ways. High blood pressure often causes no symptoms, but high blood sugar causes fatigue, blurry vision, frequent urination, and other bothersome symptoms — not to mention the risk of dire future complications like kidney failure and blindness. Wouldn’t he be motivated to prevent these? Apparently not. He did start exercising and cut down on sweets but refused to accept the medication and aggressive monitoring required to normalize his blood sugar. Also, he avoided me. When we did meet, I alternately cajoled and harangued Paul, but nothing seemed to penetrate his resistance.

A couple of years ago, seemingly out of the blue, Paul started to deal with his high blood pressure and diabetes. He ate well, exercised, took medication, and came in for scheduled appointments with me and with Leah Giunta, a nurse practitioner who provides coaching for diabetes patients in my practice.

I found Paul’s new behavior as mysterious as his old behavior.

Just recently, I asked Paul to explain both his noncompliance and his change of heart to me. I’d asked him many times before to help me understand his reluctance to take my advice but there was something about responding in writing, or perhaps responding after he’d overcome this reluctance himself, that finally allowed him to answer my questions fully. He’s kindly allowed me to share his response here:

Hi Dr. Koven:

Here’s my best take at what was behind my resistance:

1. For some reason, taking a pill every day to solve a health problem feels like a defeat, while solving the problem through behavior/diet modification feels like a success.2. A basic mistrust is triggered in me every time I witness a large marketing effort trying to push a drug on me. It goes back to the fact that somewhere along the line I developed a mistrust of the pharmaceutical companies.3. I have a spontaneous, creative, streak. It feels confining and defeating to have a regimented routine.Putting 1, 2, and 3 together, you end up with a huge resistance. Some giant drug cartel is making me follow this regimented pill-taking routine for the rest of my life, and it feels like a defeat every morning when I take the pill? NO WAY!

I believe some of the things that have contributed to me overcoming this are:

1. Symptoms of the high blood sugar finally started catching up with me, in the form of extreme fatigue and manifestations of circulatory problems, which I think was even impacting my ability to think clearly, as well as possibly leading to sores on my legs.2. The above combined with knowledge of diabetes in my family (including a relative who had both legs amputated) started making me have anxiety over what was in store. I had a very vivid dream of a guy with no legs in a wheelchair. When I woke up I realized this was me in the future if I didn’t do something drastic.3. I have gained a more balanced perspective on my distrust of pharmaceutical companies and big marketing efforts. There is truth in my concerns, but it doesn’t mean that the profit motive doesn’t also have a desirable effect, i.e. creating medications that actually solve problems.

So putting all of the above together I agreed to whatever you and Leah prescribed in conjunction with a massive new push towards behavior/diet changes. I now refer to bread as “death bread” and cookies as “death cookies.”

Last test showed blood sugar in normal range, as you know.Thanks for giving me the opportunity to reflect on this subject!Best,Paul

Reading this, I realized that there was probably little I could have said to change Paul’s mind. He was in command. The orders he awaited were his own.

_____________________________________________

Once again our TV media MOVES FORWARD 21st century ONE WORLD ONE WORLD HEALTH medicine in the US with our lovable protagonist DR HOUSE. He is that EXCEPTIONAL citizen who breaks every rule in patient care----ignores all patient and family wishes---and here we see of course he breaks US Rule of Law---breaking and entering a patient's home in diagnosis is an every day event.Of course being right while breaking all the laws surrounding medicine ONLY HAPPENS ON TV. This doctor from GLOBAL IVY LEAGUE PRINCETON getting Americans used to 21st century medicine----where a global 1% thinking themselves EXCEPTIONAL ---when in fact they are only skilled at lying, cheating, and stealing---will create this dark approach to medicine in America.THIS WAS MADE FOR A DISCUSSION IN PSYCHOLOGY CLASS REGARDING NEURAL MAPPING.The lesson ---the end justifies the means. The problem is who determines the end as positive for WE THE PEOPLE.